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In Practice

New prescription for back pain: patience


Adapted from the In Practice blog on

The doctor at the summer camp I attended as a kid believed that calamine lotion and time cured just about anything — and he was right.

Time still heals most wounds, but patience is a tough sell to people whose visits to my office often involve taking off work or getting a baby sitter, fighting traffic, and shelling out for parking and insurance co-pays. After all that, time doesn’t seem like a satisfying prescription.

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Still, an article published in JAMA Internal Medicine in September by researchers at Harvard Medical School and featured this month in Boston magazine reveals that when it comes to back pain, time is an underused treatment.

Low back pain is among the most common reasons people visit primary care doctors for non-routine care (cough tops the list). The long hours we spend commuting and sitting at computers contribute to back pain, as does obesity and “weekend warrior” syndrome. About 40 percent of adults will have low back pain at some point.

Generations ago, low back pain was called “lumbago” and treated with rest, heat, ice, massage, and various topical treatments or plasters. There’s still little evidence that much more than these are needed, in most cases. Anti-inflammatories such as ibuprofen are helpful, as well as acetaminophen. Gentle yoga or stretching are also good. As the authors of the
JAMA study, who reviewed 24,000 cases, discovered, time heals most back pain.

But, as I said, time is a tough sell, especially when there are now so many options, beyond plasters, to diagnose and treat back pain. Patients often request and doctors often recommend X-rays, MRIs, epidural injections, narcotics, referrals to specialists, and spine surgery. These treatments are often expensive, invasive, and, in the long run, no more effective than simpler approaches. Over-prescription of narcotics for back pain is particularly dangerous, as it is frequently the first step on the road to addiction.

In a small minority of cases, low back pain is a sign of a serious condition. Back pain accompanied by fever, blood in the urine, weakness or numbness in the legs, or other unusual symptoms should be evaluated by a doctor.

Patience isn’t the right treatment in all cases of back pain. (When I arrived at the camp infirmary vomiting, and with pain in my right lower abdomen, the doctor prescribed neither calamine lotion nor time — he took me to a hospital to get my appendix out.)

Less ominous episodes of back pain can also be evaluated, but a prescription of Advil, rest, yoga, and time shouldn’t feel like “doing nothing.” Sometimes “nothing” is the best treatment.

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